Mandibular Advancement Appliances Research Articles

Is adjustability advantageous in mandibular advancement appliances in the treatment of sleep-disordered breathing?

Mandibular advancement appliances (MAD) that can adjust the amount of mandibular protrusion in response to treatment results are becoming popular with dentists who treat sleep-disorder breathing. Clinicians commonly assume that they are more efficacious and more comfortable to wear than monoblock appliances. An adjustable MAD was compared with one that stabilized the mandible at 70% of the protrusive path. There was not a significant difference in their overall efficacy. The adjustable MAD appeared to be more effective in the more severe cases, presumably due to the greater mandibular advancement; the nonadjustable MAD appeared to be more effective in the less severe cases, presumably due to the greater mandibular stabilization. Existing research was examined and biomechanical principles were considered. Insufficient research exists to definitely evaluate the pros and cons of adjustability vs. stability. There does not appear to be sufficient evidence to support the assumption that adjustable MADs are more efficacious or more comfortable to wear than monoblock appliances.

Current principles in the management of obstructive sleep apnoea with mandibular advancement appliances

Current principles in the management of obstructive sleep apnoea with mandibular advancement appliances

Current principles in the management of obstructive sleep apnoea with mandibular advancement appliances.

This paper looks at the role of mandibular advancement splints in the management of obstructive sleep apnoea, as part of a multidisciplinary approach. Clinical guidance is provided on the rationale for use, patient selection, design features and the associated risk to benefit ratio.

Oral appliances for the management of severe snoring: a randomized controlled trial

The aim of this randomized controlled trial was to assess the effectiveness of a mandibular advancement appliance (MAA) in managing severe snoring. Twenty-eight adults with severe snoring and normal overnight oximetry were recruited from sleep disorder clinics. A maxillary placebo appliance and a MAA were worn by each subject for a period of 4-6 weeks each. Questionnaires at baseline and after each appliance period assessed bed partners' reports of snoring severity (loudness and number of nights per week), and patients' records of daytime sleepiness. Twenty-five subjects completed the entire trial. The MAA was significantly more effective than the placebo in reducing the frequency and loudness of snoring, the reported daytime sleepiness and the frequency of morning tiredness. Excessive salivation was the most commonly reported complication. It was concluded that the custom-made MAA was significantly more effective than the placebo in managing the main symptoms of severe snoring. However, not all subjects' partners reported an improvement with the MAA, with 84 per cent reporting a reduction in snoring loudness and 76 per cent reporting snoring on fewer nights per week.

Is Adjustability Advantageous in Mandibular Advancement Appliances in the Treatment of Sleep-Disordered Breathing?

Is Adjustability Advantageous in Mandibular Advancement Appliances in the Treatment of Sleep-Disordered Breathing?

DIAGNOSING AND COMANAGING PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME

Obstructive sleep apnea syndrome, or OSAS, is a common, but underdiagnosed, disorder that potentially is fatal. It is characterized by repetitive episodes of complete or partial upper airway obstruction leading to absent or diminished airflow into the lungs. These episodes usually last 10 to 30 seconds and result in loud snoring, a decrease in oxygen saturation, and chronic daytime sleepiness and fatigue. The obstruction is caused by the soft palate, base of the tongue or both collapsing against the pharyngeal walls because of decreased muscle tone during sleep. Potentially fatal systemic illnesses frequently associated with this disorder include hypertension, pulmonary hypertension, heart failure, nocturnal cardiac dysrhythmias, myocardial infarction and ischemic stroke. The classic signs and symptoms of OSAS may be recognizable by dental practitioners. Common findings in the medical history include daytime sleepiness, snoring, hypertension and type 2 diabetes mellitus. Common clinical findings include obesity; a thick neck; excessive fat deposition in the palate, tongue (enlarged) and pharynx; a long soft palate; a retrognathic mandible; and calcified carotid artery atheromas on panoramic and lateral cephalometric radiographs. Dentists cognizant of these signs and symptoms have an opportunity to diagnose patients with occult OSAS. After confirmation of the diagnosis by a physician, dentists can participate in management of the disorder by fabricating mandibular advancement appliances and performing surgical procedures that prevent recurrent airway obstruction.

Eficacia de una prótesis de avance mandibular en el tratamiento del síndrome de apneas obstructivas del sueño

To assess the efficacy of a mandibular advancement prosthesis for treating obstructive sleep apnea syndrome (OSAS). Mandibular advancement appliances were prescribed for 21 patients (20 men) with OSAS diagnosed by polysomnography. Mean age was 51 (8) years, BMI was 30 (4) kg/m2, and the apnea-hypopnea index (AHI) per hour was 48 (17). If the device was well tolerated, regardless of clinical response, polysomnography was repeated between 1 to 3 months after start of treatment. The device was considered effective if the AHI decreased to < 15/h and symptoms related to OSAS disappeared. Seven patients withdrew from treatment after only a few days. The remaining 14 (66%) tolerated treatment well and the second polysomnogram was performed. In six of the 14 (43%), the device proved effective for correcting OSAS. In six more patients, the AHI decreased but failed to become normal. In the remaining two patients, no improvement was observed. Improvement in the AHI was unrelated to severity of OSAS. The mandibular advancement prosthesis is effective for some patients with OSAS, including those in whom the AHI is high. Larger studies are needed to allow us to define the type of patients that might benefit.

Dentistry's role in the diagnosis and co-management of patients with sleep apnoea/hypopnoea syndrome.

The sleep apnoea/hypopnoea syndrome (SAHS) is characterized by repeated upper airway narrowing or collapse during sleep. The obstruction is caused by the soft palate and/or base of tongue collapsing against the pharyngeal walls because of decreased muscle tone. These episodes are accompanied by hypoxaemia, surges in blood pressure, brief arousal from sleep and pronounced snoring. Individuals with occult disease are at heightened risk of motorway accidents because of excessive sleepiness, sustained hypertension, myocardial infarction, and stroke. The signs and symptoms of SAHS may be recognisable in the dental practice. Common findings in the medical history include daytime sleepiness, snoring, hypertension, and type 2 diabetes mellitus. Common clinical findings include male gender, obesity, increased neck circumference, excessive fat deposition in the palate, tongue (macroglossia) and pharynx, a long soft palate, a small recessive mandible and maxilla, and calcified carotid artery atheromas on panoramic and lateral cephalometric radiographs. Dentists who recognise these signs and symptoms have an opportunity to diagnose patients with occult SAHS. After confirmation of the diagnosis by a physician, dentists can participate in the management of the disorder by fabricating mandibular advancement appliances that enlarge the retroglossal space by anterior displacement of the tongue and performing corrective upper airway surgery that prevents recurrent airway obstruction.

Evaluation of Variable Mandibular Advancement Appliance for Treatment of Snoring and Sleep Apnea

To evaluate an adjustable mandibular positioning appliance for treatment of snoring and sleep apnea. One hundred thirty-four patients with baseline apnea/hypopnea index (AHI) of 37 +/- 28 events/h (mean +/- SD) received the appliance. The efficacy of the appliance was assessed by the following investigations, performed at baseline and with the appliance: polysomnography, Epworth sleepiness scale, bedpartners' assessment of snoring severity, patients' assessment of side effects, and overall satisfaction. Thirteen patients were lost to follow-up. An additional 46 patients had no follow-up polysomnography, but answered the questionnaires. A total of 75 patients had polysomnography at baseline and with the appliance. We found a significant reduction in AHI from 44 +/- 28 events/h to 12 +/- 15 events/h (p < 0.0005) and a reduction in the arousal index from 37 +/- 27 events/h to 16 +/- 13 events/h (p < 0.05). Epworth scores fell from 11 +/- 5 to 7 +/- 3 (p < 0.0005). Bedpartners' assessment revealed marked improvement in snoring. For example, at baseline 96% of patients were judged to snore loudly "often" or "always" by their bedpartners, whereas only 2% were judged so while using dental appliance. The most frequent side effect was teeth discomfort, present "sometimes" or "often" in up to 32% of patients. Follow-up clinical assessment in 121 patients conducted on the average 350 days after the insertion of the appliance revealed that 86% of patients continued to use the appliance nightly; 60% were very satisfied with the appliance, 27% were moderately satisfied, 11% were moderately dissatisfied, and 2% were very dissatisfied. We conclude that the adjustable mandibular positioning appliance is an effective treatment alternative for some patients with snoring and sleep apnea.

An investigation into the changes in airway dimension and the efficacy of mandibular advancement appliances in subjects with obstructive sleep apnoea.

This prospective clinical study evaluates a group of 37 male Caucasians with obstructive sleep apnoea for changes in airway dimension and the efficacy associated with the use of mandibular advancement splints. Lateral skull radiographs were obtained with the subjects--upright in occlusion, supine in occlusion, and supine in protrusion. Each radiograph was traced and digitized, and changes in mandibular position, airway dimensions, and hyoid were examined. Subjects were invited to complete pre- and post-treatment questionnaires, and interviewed following fitting of a removable Herbst mandibular advancement splint. Significant changes were recorded in the airway dimensions in response to both a change in position, from upright to supine, and in response to mandibular advancement. A compliance rate of 76 per cent was achieved with no reported serious complications associated with the use of mandibular advancement devices.

Obstructive sleep apnea: Oral appliance therapy and severity of condition

Objective. The purpose of this study was to determine whether an oral appliance can effectively treat severe obstructive sleep apnea. Design. The study was conducted at a tertiary care military facility with an accredited sleep laboratory. Results of the treatment of the first 25 patients with obstructive sleep apnea referred for oral appliance therapy were retrospectively analyzed. Each patient received a mandibular advancement appliance and underwent polysomnography 2 weeks after delivery of the appliance. Patients were divided into two groups: those with slight-to-mild obstructive sleep apnea who had a respiratory disturbance index less than 21, and those with more severe disease. Treatment was considered to be successful if the posttreatment respiratory disturbance index was less than 5. Results. Nine (90%) of the 10 patients with slight-to-moderate disease were successfully managed with the oral appliance. Of the 15 patients in the moderate-to-severe group, 9 (60%) were successfully managed. Conclusion. Oral appliances have commonly been recommended only for mild obstructive sleep apnea. This study indicates that they may also have a role to play in selected cases in which the condition is more severe. There is a paucity of information about long-term success. This short-term (2-week) study should be followed by others evaluating the effect over longer periods.